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Full text of "Wounded, Ill and Injured Project 2013 Annual Report"

Corporal Josue Barron 
lost his left leg and left 
eye in an improvised 
explosive device blast 
Oct. 21,2010. But he will 
never forget where he 
came from or who he is: a 
member of 3rd Battalion, 
5th Marine Regiment ... 
the Darkhorse Battalion. 
It is this pride that 
drives him to excel as he 
competes against other 
Wounded Warriors in the 
2012 Marine Corps Trials. 
(Photo by Sergeant Mark 
Fayloga) 






Wounded, In, and Injured Project 
FY2013 Annual Report 

Public Health Support for Our Nation's Warriors 




NAVY AND MARINE CORPS PUBLIC HEALTH CENTER 

PREVENTION AND PROTECTION START HERE 



NAVY AND MARINE CORPS PUBLIC HEALTH CENTER 

PREVENTION AND PROTECTION START HERE 

Wounded, III, and Injured Project 
FY2013 Annual Report 

620 John Paul Jones Circle, Suite 1100 

Portsmouth, VA 23708-2103 

www.nmcphc.med.navy.mil 

Published: March 31,2014 




Scan this QR code to contact us 
with questions and feedback! 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Table of Contents 

Message from the Commanding Officer ii 

Dedication 1 

Executive Summary. 2 

NMCPHC Wll Program Description: History, Overview, and Strategic Alignment 4 

Healthy and Fit Force 8 

Prevention and Protection 10 

Medical and Rehabilitative Care 13 

NMCPHC Wll Program Products and Services 15 

Wll 141 Project: Expanded Surveillance and Metrics Support 15 

Wll 141A Project: Health Promotion and Wellness 25 

Wll 141B Project: Health Hazard Assessment 29 

Wll 141C Project: Navy Entomology Center of Excellence 31 

The Mission Ahead for NMCPHC 35 

Appendix A: References 37 

Appendix B: Contact Information - NMCPHC Wll Program 38 

Appendix C: Acronym List 39 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Message from the Commanding Officer 




Captain Michael J. Macinski 

"The Navy and Marine Corps Public 
Health Center's commitment to 
serving our Sailors, Marines, and 
their families remains as enduring 
as their commitment and sacrifice in 
support of our nation's freedom." 



During the past 10 years of armed conflict, the military's emphasis on the three pillars of Force Health 
Protection (FHP) - Healthy and Fit Force, Prevention and Protection, and Medical and Rehabilitative 
Care - resulted in the lowest rates of non-combat injuries in history and proved to be essential 
components of warfighter effectiveness. Despite these impressive results, service members are still 
returning from war with complicated burdens of physical and mental injuries. Traumatic brain injury, post- 
traumatic stress disorder, substance abuse issues, traumatic limb amputations, and an alarming rate of 
suicidal behavior pose vastly different public health challenges than those seen in past conflicts. The 
Navy and Marine Corps Public Health Center (NMCPHC) has adapted and evolved throughout its 50- 
year Naval and public health history to undertake these challenges as well as support the 21st Century 
Sailor and Marine Initiative. Because of this, Navy Medicine turned to us for support in addressing the 
unique needs of these wounded, ill, and injured (Wll) Sailors and Marines, and their families. 

NMCPHC embodies Navy Medicine's commitment to the Wll population. We enhance the readiness, 
effectiveness, and resilience of fighting forces worldwide through evidence-based population health 
strategies and services. NMCPHC products and services enable data-driven outcomes for Wll 
service members by blending surveillance, health analytics, and health promotion. We develop early 
intervention, detection, prevention, recovery, and resiliency programs for Sailors and Marines dealing 
with the effects of war - focusing our efforts on physical, behavioral, and psychological health threats. 
We collaborate with a variety of health professionals to deliver effective, world-class products for 
healthcare providers, military health professionals, and Wll service members and their loved ones. 

I proudly present our NMCPHC Wll Project FY2013 Annual Report that delineates the accomplishments 
and benefits of our Wll products and services. Building on early program success and experience, 
NMCPHC enhanced existing projects and developed new ones in fiscal year 2013. Some of our most 
notable successes this year included: 

► Developed and utilized metrics to evaluate the effectiveness of Wll projects throughout Navy 
Medicine to contribute to health process improvements for wounded service members. 

► Served as subject matter experts and delivered detailed clinical analysis for Navy suicide case 
reviews at the request of the Chief of Naval Operations and Navy Surgeon General. Our efforts 
contributed to enhanced suicide prevention strategies. 

► Expanded the Navy's Periodic Occupational and Environmental Monitoring Summary Program to 
include five new summaries that quantify the health risks associated with environmental stressors and 
exposures during deployment. 

► Piloted a Wll Health Risk Assessment tool designed to identify healthy and unhealthy behaviors that 
affect the healing, recovery, and psychological health of Wll Sailors and Marines. 

► Certified 197 deployable scientists and technicians as proficient and deployment-ready to conduct 
health hazard assessments. 

► Earned a recommendation for the Navy Entomology Center of Excellence to be designated as 
a World Health Organization (WHO) Collaborating Centre by the scientist in charge at the WHO 
Pesticide Evaluation Scheme. 

NMCPHC invests its distinct capabilities across the full spectrum of FHP and will continue to refine and 
develop data-driven strategies and methods to prevent illness, improve physical and behavioral health, 
reduce costs, and maximize force readiness. The resulting products provide value not only to the Navy, 
but to other services in the United States (U.S.) military. I remain confident that NMCPHC's commitment 
to serving our Wll Sailors, Marines, and their families will endure alongside their commitment and 
sacrifice to protect our nation's freedom. 



M. J. MACINSKI 
Captain, Medical Service Corps 
United States Navy 
Commanding Officer 




ii Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




This report is dedicated to our nation's Sailors and Marines. 
NMCPHC is committed to protecting their health and 
enhancing their well-being. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 1 




Executive Summary 

The Navy and Marine Corps Public Health Center (NMCPHC) 
provides worldwide Force Health Protection (FHP) services to 
ensure readiness and resilience of Sailors and Marines wherever 
they might be - from the deck of an amphibious assault ship, in 
the sands of Afghanistan, or the barracks at Camp Pendleton. 
NMCPHC protects the population through occupational and 
environmental medicine, disease surveillance and monitoring, 
health promotion education and training, and prevention programs. 
These programs support efforts throughout the Department of 
Defense (DOD), including the Department of the Navy's (DON) 
21st Century Sailor and Marine Initiative, to monitor and analyze 
disease data, promote healthy living, consult on health risk issues, 
and shape public health in the Navy. 

NMCPHC uniquely refines and targets programs and services to 
support specific Navy Medicine programs through the Wounded, 
III, and Injured (Wll) Project and Medical Home Port (MHP). 
Four complementary projects provide analytical and preventive 
expertise in support of the Wll Project: 

► Wll 141 Expanded Surveillance and Metrics Support 

► Wll 141A Health Promotion and Wellness 

► Wll 141B Health Hazard Assessment 

► Wll 141C Navy Entomology Center of Excellence 



Collectively, these projects are the NMCPHC Wll Program. The 
NMCPHC Wll Program supports FHP, a unified strategy that 
provides integrated preventive and clinical programs designed to 
protect service members, by advancing three interrelated pillars: 
Healthy and Fit Force, Protection and Prevention, and Medical and 
Rehabilitative Care, as depicted in Figure 1. The goal of FHP is to 
provide a fit and healthy force, protected from disease and injury, 
when and where the mission requires it, while simultaneously 
adapting the medical forces to be more technologically advanced, 
smaller, and more mobile. Overall, the NMCPHC Wll Program: 

► Creates products and services that support readiness, decrease 
disease and illness, facilitate recovery, and enhance resilience. 

► Designs and refines data collection methodologies that ensure 
the effectiveness of Navy Medicine services for Wll service 
members. 

► Delivers reports and programs that generate actionable 
information, products, and services to enable data-driven 
policies, risk mitigation decisions, and clinical care guidelines. 

► Collaborates with sister Services, the Defense Health Agency 
(DHA), and other federal agencies to evaluate and improve the 
health of the Wll population. 



2 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



EXECUTIVE SUMMARY 




Figure 1: NMCPHC Wll Program supports the three Force Health Protection pillars 



This annual report demonstrates how FHP serves as the foundation 
of the command's Wll Program and how the projects collectively 
improve public health of Wll service members throughout the Navy 
and Marine Corps. NMCPHC's Wll products and services play 
a significant role in achieving readiness in the Navy and Marine 
Corps, as indicated by key accomplishments from fiscal year (FY) 
2013 highlighted in this report. 

As the nation continues to defend democracy around the globe and 
provide humanitarian assistance in response to natural disasters, 
the U.S. military must be in a constant state of readiness and 
prepare service members both physically and psychologically to 
fulfill their mission. NMCPHC continues to advance FHP through 
collaborative and innovative programs that improve the readiness, 
resilience, and recovery of Wll Sailors and Marines. 



"NMCPHC products and services are 
critical to the readiness, resilience, and 
recovery of Wll service members. Our 
expert staff assist and develop solutions 
that directly impact Sailors and Marines 
and arm leadership with information to 
make effective and educated decisions 
related to healthcare. We are proud to 
provide Sailors, Marines, and their families 
with products and services that yield a 
lasting, positive impact on our military 
communities." 

- Mr. William Calvert, Deputy Director 
for Population Health at NMCPHC 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




NMCPHC Wll Program Description: History, Overview, and 
Strategic Alignment 



HISTORY 



The mission of NMCPHC is to provide worldwide FHP services to 
Naval and Joint Forces in support of the National Military Strategy. 
The NMCPHC Wll Program provides specialized FHP analysis and 
products designed to strengthen Navy Medicine's ability to promote, 
protect, and restore the mental and physical well-being of Sailors 
and Marines. NMCPHC Wll efforts span the spectrum of FHP from 
enabling a healthy and fit force to analyzing medical and 
rehabilitative care. 

First funded in FY2010, NMCPHC developed the Wll 141 Project 
at the request from Navy Medicine leadership to provide a detailed 
assessment of the circumstances and needs of Wll Sailors and 
Marines. Since its inception, Bureau of Medicine and Surgery 
(BUMED) leadership and program evaluations have identified 
a favorable return on investment for the project, noting a strong 
surveillance capability supported by staff that delivered high quality 
data analyses. These robust capabilities established the foundation 
for innovative services that will continue to produce a return on 
investment well into the future. As the project progresses, NMCPHC 
expects to reduce healthcare expenses and improve clinical results 
by arming Sailors and Marines with information that promotes healthy 
lifestyle choices, providing data analysis to influence healthcare 
decisions, and developing cutting-edge products to protect 
service members. 



Report History 

This year's annual report details the 
breadth and depth of services provided 
by NMCPHC during the FY2013. The 
first published report, the NMCPHC 
Wll Project 141 Progress Report, 
encompassed the accomplishments from 
the project's inception in 2010 to March 
2012; the second report, the NMCPHC 
Wll Project 2012 Annual Report, featured 
products and services delivered by the 
Wll projects in calendar year (CY) 2012. 
Given the difference in time parameters, 
the FY2013 annual report includes 
some accomplishments reflected in the 
2012 report. NMCPHC will continue 
to provide annual reports that include 
accomplishments completed within 
the fiscal year, highlight collaboration 
among the project teams and across 
organizations, and demonstrate key 
findings and impacts of each achievement. 



4 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



NMCPHC Wll PROGRAM DESCRIPTION: 
HISTORY, OVERVIEW, AND STRATEGIC ALIGNMENT 



OVERVIEW 



Four distinct Wll projects embody the NMCPHC Wll Program: 
Wll 141 Expanded Surveillance and Metrics Support, Wll 
141 A Health Promotion and Wellness (HPW), Wll 141 B Health 
Hazard Assessment (HHA), and Wll 141C Navy Entomology 
Center of Excellence (NECE). The program offers products 
and services targeted to providers, scientists, commanders, 
leadership, and individuals. Navy physicians gain valuable 
reports on patients throughout the care continuum from health 
surveillance and health hazard assessment in theater to utilization 
of Military Treatment Facility (MTF) services and resilience 
building practices. The program arms military leaders with the 
tools to develop and maintain a fit and deployable force, and 
provides operational commanders with real-time information to 
avoid or mitigate environmental exposures ensuring the protection 
of troops from health hazards that decrease readiness. 



According to Rear Admiral Walter "Ted" 
Carter, Director of the 21st Century Sailor 
Office, "Resilience is not one program or 
initiative, but a comprehensive effort to 
build life skills that not only ensure Navy 
readiness, but also fully develop the personal 
and professional talent of our force. " 



The NMCPHC Wll Program uses modern data science and health 
analysis techniques to generate reports that drive leadership 
decisions and develop outreach programs that increase the 
readiness and resilience of service members by promoting 
healthy behaviors. The Expanded Surveillance and Metrics 
Support Project analyzes Navy-wide Wll programs to drive 
effective healthcare services, reduce healthcare expenses, 
improve clinical results, and deliver epidemiological surveillance to 
prevent disease and injury. The HPW Project extends prevention 
efforts through evidence-based health promotion and wellness 
programs that hasten recovery and promote healthy lifestyles. 
Collaboration between these two projects promotes the seamless 
integration of sophisticated data analysis with targeted health 
promotion strategies to deliver innovative programs relevant to real 
world settings. NMCPHC's applied analysis approach provides a 
dynamic and versatile capability for the Navy and Marine Corps 
that translate public health analysis into actionable outcomes that 
promote health and support force readiness. 

NMCPHC's two deployed warfighter protection projects, HHA 
and NECE, support the ongoing assessment of deployed health 
hazards and the prevention of vector-transmitted diseases. HHA 
supports deployment health by providing operational commanders 
timely risk assessments to control and mitigate hazardous 
situations. NECE serves as an international authority on effective 
ways for safeguarding human life from blood-feeding insects that 
carry human disease and sustaining a lasting, positive impact on 
warfighters and at-risk populations. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public He 



NMCPHC Wll PROGRAM DESCRIPTION: 

HISTORY, OVERVIEW, AND STRATEGIC ALIGNMENT 



ALIGNMENT TO FORCE HEALTH PROTECTION 



The NMCPHC Wll Program impacts health outcomes of 
service members during all phases of deployment and across 
the three FHP pillars, as depicted in Figure 2. For example, 
NMCPHC provides surveillance reports during Pre-Deployment 
preparations that offer insight on unit health trends and develops 
or recommends health promotion products to assist individuals 
in achieving optimal readiness. During the Deployment phase, 
NMCPHC provides HHA training for preventive medicine 
technicians to help identify and mitigate health hazards on the 
battlefield. Scientific advancements of the NECE Wll staff protect 
service members from debilitating insect-borne illnesses. 



Wll 141 surveillance activities capture and analyze medical, 
personnel, and operational databases to assess the health 
and well-being of wounded personnel throughout deployment. 
NMCPHC supports the Post-Deployment and Rehabilitation 
phases through epidemiological analysis of the medical and 
rehabilitative care delivered in garrison. These analyses and 
reports outline the burden of disease and associated care and 
are utilized to ensure appropriate allocation of resources. As 
the deployment cycle is a continuous loop, the needs of the 
Wll population are constantly re-examined and NMCPHC Wll 
products and services are refined to reflect any changes. 




PREVENTION & PROTECTION 



Wll 141 Project 
Wll 141 A Project 
WH 141 B Project 
Wll 141C Project 

Behavioral & Mental Health Reports 
Epidemiological Surveillance 
Periodic Occupational & Environmental 
Monitoring Summary [POEMS} 



Wll 141 Project 

Wll 141 A Project 

Navy Suicide Case Reviews 

Case Management 

Health Education Resources 



; REHABIIITATIVE CARE 



Wll 141 Project 

Wll 141 A Project 

WM Project Evaluations 

Access to Care Reports 

Quality of Care Reports 

Transition of Care Reports 

Mental Heath Care Analysis 



Figure 2: NMCPHC Wll Products and Services Alignment to Force Health Protection 



6 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



NMCPHC Wll PROGRAM DESCRIPTION: 
HISTORY, OVERVIEW, AND STRATEGIC ALIGNMENT 



ALIGNMENT TO POD AND NAVY STRATEGIES 

In addition to supporting the goals of FHP, the NMCPHC Wll 
Program also aligns to the DHA's Quadruple Aim and Navy 
Medicine Strategic Priorities (Readiness, Value, and Jointness), 
as depicted in Figure 3. Readiness, Value, and Jointness support 
Navy Medicine in its mission to enable healthcare that is patient- 
centered and provides the best value, preserves health, and 
maintains readiness. DHA's Quadruple Aim strives to achieve 
medical readiness, improve health, enhance the experience of 
care, and lower healthcare costs - important efforts of the Wll 
Program. The command's Wll projects also support the National 
Prevention Strategy, Total Force Fitness for the 21st Century 
framework, and Navy-wide strategic efforts such as the 21st 



Century Sailor and Marine Initiative. Each of these strategies 
coincides with the readiness, resilience, and wellness of Sailors 
and Marines - all related to the continuum of care NMCPHC 
strives to support. These guiding frameworks serve as a 
foundation for the NMCPHC Wll Program to align products, 
services, and strategies that are relevant to today's focus and 
tomorrow's goals. NMCPHC also strives to influence future 
initiatives through the Wll Program's detailed analyses and 
innovative solutions. The subsequent pages in this report describe 
in detail the purpose of each project and key accomplishments 
that contribute to the health and well-being of the Wll population 
and overall support to Navy Medicine. 









READINESS 


POPULATION HEALTH 


EXPERIENCE OF CARE PER CAPITAL COST 



in 

CD 
O 

'£ 

CD 
CO 

-H2 
o 
zs 
■o 
o 

CL 
O 

zn 

Q_ 

O 



READINESS 



VALUE 



JOINTNESS 




Deliver ready capabilities to the operational 
commander 

Deliver relevant capability and capacity for 
Theater Security Engagement operations 



■ Decrease enrollee network cost/ Increase 

recapture of Purchased Care 
• Realize full benefit from Medical Home 

Ports and Neighborhoods 



■ Leverage joint initiatives to optimize 
performance of Navy Medicine's 
mission 

• Improve Navy Medicine interoperability 



Force Health 
Reports 



Project 
Evaluations 



Health Promotion 
Projects 



Evaluations of 
Insecticides & 
Application Equipment 



Access to Care 
Reports 



Behavioral and 
Mental Health 
Reports 



Health Analytic 
Projects 



Geographic 
Information Systems 
(GIS) Capability 



Epidemiological 
Surveillance 



Navy Suicide 
Case Reviews 



Health Education 
Resources 



Case 
Management 




Mental Health Care 
Analysis 



Periodic Occupational & 
Environmental Monitoring 
Summary (POEMS) 




Navy Medical Strategic Enabling Objectives: Optimize use of medical informatics, technology, and telehealth // 
Standardize clinical, non-clinical, and business processes // Improve communications and alignment 



Figure 3: NMCPHC Wll Products and Services Alignment to DHA Quadruple Aim and 
Navy Medicine Strategic Priorities 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Supportfor Our Nation's Warriors 




Photo by Mass Communication Specialist 2nd Class Kenneth R. Hendrix 



Healthy and Fit Force 

The goal of the first FHP pillar is to ensure a healthy and fit force 
that is mission ready, combat resilient, and reliable. Promoting 
wellness and reducing preventable illness and injury are key 
tools in achieving this pillar. The majority of this care occurs in 
garrison, i.e., in home port largely delivered from fixed medical 
treatment facilities. 



Research over the past 10 years reported 
strong evidence of the cost savings from health 
promotion programs, including integrative 
psychological health prevention efforts (Adams 
2009, Chapman 2003, Katz and Ali 2006). 



Through the Wll 141 and Wll 141A Projects, NMCPHC 
offers tailored informational tools, materials, and programs 
to encourage healthy lifestyle choices and conducts 
epidemiological surveillance to provide leadership with 
recommendations to minimize the impact of preventable injury 
and disease. Specific examples of how NMCPHC contributed to 
rehabilitation initiatives within the Wll population include: 

► Developed and presented the "Road to Recovery - Healthy 
Living Recommendations to Incorporate into Your Recovery 
Plan" webinar to educate Wll service members and caregivers 
on tobacco cessation, injury prevention, weight management, 
and nutrition during illness or injury. 



► Created the "Life After an Amputation" webpage to provide 
resources on physical activity, assistive technology, nutrition, 
healthy living, veterans services, recreation and adaptive 
sports, and emotional well-being that promote a successful 
recovery during rehabilitation for amputees. 

► Developed nine fact sheets for case managers that address 
the health behavior needs of Wll patients based on feedback 
from an assessment that determined what services, tools, and 
educational resources would be most beneficial for those who 
provide case management services. 

NMCPHC also addressed the psychological and emotional well- 
being of service members to encourage strong coping skills that 
will improve individual focus on mission requirements. 

► Provided subject matter experts in epidemiology, clinical 
data analysis, and health education for Navy suicide case 
reviews that resulted in recommendations to policy changes 
and prevention practices. Spotlight 1 describes NMCPHC's 
contributions to the prevention of suicide through the Wll 141 
and Wll 141A Project experts. 

► Redesigned and updated the Relax, Relax Toolkit to help 
Sailors and Marines who are facing stress and psychological 
and emotional issues. The toolkit now includes a larger, more 
diverse selection of music and new sections on mindfulness, 
sleep, relaxation techniques, and coping strategies. 




8 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



HEALTHY AND FIT FORCE 



Spotlight 1. Utilizing Healthcare Data to Improve Suicide Prevention Initiatives 

At the request of the Chief of Naval Operations and Navy Surgeon General, epidemiologists, clinical data analysts, 
and health educators from the Wll 141 and Wll 141A Projects participated in both the Office of the Chief of Naval 
Operations (OPNAV) Suicide Case Review and the Navy Surgeon General's Deep Dive Suicide Case Review. 

NMCPHC Wll Program experts collaborated with suicide specialists, suicide prevention coordinators, and medical 
personnel to identify trends, gaps, and potential points of intervention to reduce suicide attempts and deaths by suicide. 
The team performed a thorough review of all Navy suicide deaths and used the NMCPHC's clinical data analysis to 
help develop recommendations for prevention efforts. The case reviews were vital in the identification of risk factors, 
potential areas of intervention, and access to care concerns. 

The collaborative report from the deep dive review was presented to the Navy Surgeon General with recommendations 
for how Navy Medicine can promote psychological and emotional well-being and reduce suicides. A DON working 
group used this information to develop the Vice Chief of Naval Operation's Task Force Resilient Final Report. The Task 
Force Resilient Final Report, in turn, influenced Navy strategy and resulted in the establishment of the 21st Century 
Sailor Office to address and manage resilience promotion, behavioral health, suicide prevention, and wellness strategy. 
NMCPHC also contributed to a special Navy report, Attempted Suicides and Deaths: 2011-2012, to improve knowledge 
of suicide trends among Sailors and aid in identification of treatment methods and intervention programs. 



The Wll Program provided several advanced analyses of 
electronic health data and health conditions impacting the Wll 
population which have cost savings potential for Navy Medicine. 
NMCPHC epidemiologists and programmers provided near real- 
time reporting on health concerns affecting Wll service members, 
including behavioral health and amputations, to identify injuries 
and illness impacting mission readiness. Key examples of Wll 141 
and Wll 141A health assessment activities include: 

► Developed and tested a Health Risk Assessment (HRA) tool 
tailored to the specific health concerns of Wll service members 
such as prescription drug use, pain, intimacy, and the use of 
complementary and alternative medicine. The tool identifies 
healthy and unhealthy behaviors that may affect healing, 
recovery, psychological health, and overall resilience to improve 
awareness of these issues between healthcare providers and 
service members. The only tool of its kind, the Wll HRA will 
provide a baseline of data for health educators to plan and 
implement community interventions. 



Provided quarterly incidence reports detailing the prevalence 
rates of alcohol and substance abuse among Navy and Marine 
Corps service members for the Vice Chief of Naval Operations 
and BUMED M9 to target strategies for reducing substance 
abuse. 



A Healthy and Fit Force is 

mission ready, combat resilient, 
and reliable. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




Prevention and Protection 



Prevention and protection is the second FHP pillar and addresses 
two types of threats for deployed troops: disease and non-battle 
injury (DNBI) and enemy or terrorist threats. The NMCPHC Wll 
Program addresses both threats by identifying potential health risks, 
developing courses of action, and advising commanders of risks 
and threat countermeasures. Wll prevention and protection activities 
such as health and environmental surveillance, health hazard 
assessments, and vector control provided through the Wll 141, Wll 
141A, Wll 141 B, and Wll 141 C Projects are essential to sustaining 
the health of the force as well as improving the recovery of the Wll 
population. 

DNBIs demonstrate the greatest threat to readiness and are 
responsible for more morbidity than illness or injury deliberately 
inflicted by the enemy. NMCPHC Wll surveillance and health 
promotion projects helped reduce this DNBI burden by providing 
commanders analysis and metrics to support prevention efforts and 
maintain safe and healthy working environments for their troops. In 
FY2013, NMCPHC: 

► Provided quarterly metric analysis of deployment limiting 
conditions, such as behavioral health conditions and orthopedic 
injuries in shipboard Navy service members to improve clinical 
practices, resource allocation, and support policies to implement 
evidence-based practices. The analysis informs key customers 
within the Agile Capabilities Working Group of conditions reducing 
mission readiness among shipboard service members 



and supports program development and readiness analysis of 
Naval Forces. 

► Conducted analysis of foot and ankle crush injuries among 
Marine Corps combat engineers at Camp Lejeune from 2011 to 
2012 to evaluate the impact of these injuries and influence injury 
prevention efforts. 

► Identified patients with genital injuries to confirm case findings 
and burden in the Marine Corps in response to a request from 
the Wounded Warrior Regiment. These types of tailored reports 
allow providers to identify and follow up with patients to assure 
they receive proper care for the entire treatment period, achieve 
recovery, and return to work. 

NMCPHC experts use epidemiological surveillance to track disease 
and injury incidence in the Navy and Marine Corps population. 
Effective epidemiological surveillance prevents illness and injury 
through early detection and combines healthcare data with 
personnel, environmental, and operations data. The Force and 
Fleet health surveillance reports assist in identifying behavioral 
health outcomes, including Post-Traumatic Stress Disorder (PTSD), 
Traumatic Brain Injury (TBI), Major Depressive Disorder (MDD), 
and Substance Use Disorder (SUD). The surveillance reports 
allowed medical staff to respond at the unit level and enabled data- 
driven corrective actions. Resulting analyses also enable effective 
resource allocation to target unique units. Specific NMCPHC health 
surveillance analysis products include: 



10 Wounded, ill, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



PREVENTION AND PROTECTION 



► TBI and Mild Traumatic Brain Injury (mTBI) Incidence Reports 
for BUMED to identify changing trends and build policies based 
on analysis of TBI incidence in the Navy and Marine Corps. 
The project also provided yearly incidence and prevalence 
trends of TBI among active duty Navy and Marine Corps 
service members and information on severity, follow-up care, 
and demographics of the patient population. This information 
identified MTFs that require resources to care for Wll service 
members and allowed Navy Medicine to compare and assess 
TBI programs and care across the enterprise. 

► The Navy Expeditionary Combat Command (NECC) Wll 
Registry that identified NECC service members diagnosed 
with injuries and behavioral health conditions. The information 
influenced specific prevention strategies that minimize the 
impact of preventable injury and disease and improve military 
health readiness. 

► Unit-specific Force Health Surveillance Report for the Civil 
Engineering Corps detailing monthly trends of behavioral 
health encounters, TBI, positive behavioral health screens on 
the Post- Deployment Health Reassessment (PDHRA), and 
extended use of prescription medications in CY2012 to evaluate 
population health and assess trends. 

► Identification of antibiotic resistant infections in the Wll 
population for use by infection control practitioners at military 
treatment facilities to support efforts to improve care. 

NMCPHC also analyzes occupational and environmental 
health surveillance to advise leadership of potential health 
risks encountered during deployments, including biological and 
chemical terrorist threats. Health hazard assessments such as 
Periodic Occupational and Environmental Monitoring Summaries 
(POEMS) assess health risks for populations deployed to 
specific sites and can be used to provide reliable assessments of 
deployment-related environmental exposures. Military providers 
use this information to care for the Wll population; this information 
is also critical for care when Wll service members transition to the 
Department of Veterans Affairs. NMCPHC experts train personnel 
in field preventive medicine techniques and calibrate equipment 
to provide operational commanders timely risk assessments 
to guide, control, and mitigate deployment hazards in theater. 
NMCPHC also develops products and services to protect service 
members against environmental hazards, blood-feeding insects 
that carry human disease, and occupational stressors. Products 
and services include: 

► POEMS to evaluate the health risks associated with chemical, 
biological, and physical stressors faced by deployed warriors 



developed for Camp Lemonnier, Camp Fallujah, Al Asad Air 
Base, Camp Leatherneck-Bastion, and Camp Dwyer. POEMS 
assessed the significance of both short-term and long-term 
health risks for populations deployed to specific sites and 
improved population health surveillance. POEMS can be used 
to provide defensible, definitive assessments of deployment- 
related environmental exposures to medical practitioners, 
service members, stakeholders, and other services in the 
U.S. military. 

► Calibration of field-portable analytical equipment which helped 
identify, eliminate, and document personnel exposures to 
environmental health stressors in the deployed environment. 

► Quarterly execution of proficiency analytical testing (PAT) 
of healthcare scientists which confirmed proficiency in 
identification, assessment, and control of personnel exposures 
to environmental health stressors in the expeditionary 
environment. The PAT training ensures Forward Deployable 
Preventive Medicine Units (FDPMUs) are capable to deploy 
modern field-portable analytical equipment proficiently in 
different areas. 

► Development of a multi-functional, lightweight, durable, 
compressed air backpack sprayer that addressed a capability 
shortfall for applying residual insecticides to a variety 

of surfaces. Recommended by the Armed Forces Pest 
Management Board's (AFPMB) Equipment Committee and 
approved by the AFPMB Council, the Dorendorf JQSX sprayer 
received a National Stock Number (NSN) and is now listed on 
the approved equipment list and in use by the Navy's FDPMUs. 

► Patented innovative method for producing long-lasting 
insecticide-treated bed nets to combat the spread of malaria in 
Africa and Asia, improving the product durability from about 8 
months to at least 2 years before needing replacement. These 
types of innovations led to recognition from the World Health 
Organization (WHO) as detailed in Spotlight 2. In addition, 
royalties from the net sales will provide a substantial source of 
funding for the Navy, conservatively estimated to be between 
$1 million and $1.8 million each year. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 11 



Protection and Prevention is 

essential to sustaining the health 
of the force and improving the 
recovery of the Wll population. 



PREVENTION AND PROTECTION 



Spotlight 2. Becoming an International Leader: NECE recommended for World Health Organization Collaborating 
Centre Designation 

The scientist in charge at the WHO Pesticide Evaluation Scheme visited NECE to evaluate the Center's equipment testing 
and evaluation capabilities after receiving a referral from a NECE partner. As a result of this visit, NECE was recommended 
to become a WHO Collaborating Centre (WHO CC) for testing insecticide application equipment, the only DOD center to be 
recognized as such. As a WHO CC, NECE will: 

► Serve as an international center of excellence for public health insecticide application methods. 

► Recruit more collaborative research efforts from national and international federal laboratories, universities, and industries 
resulting in new and improved products to protect deployed warfighters from insects that transmit diseases. 

► Engage in joint initiatives that help promote global health thus supporting a key national security priority for the DOD and Navy. 

► Receive reimbursable funding from the WHO to test and evaluate insect control products for industry organizations that seek 
to market goods in developing countries with WHO approval. 

► Receive reimbursable travel funding on behalf of the WHO for subject matter experts to provide training in developing 
countries for public health and preventive medicine personnel. 



Chief Hospital Corpsman Emeterio Donato, chief of the preventive 
medicine team for Camp Lemonnier's expeditionary medical facility, 
tests the pH of the drinking water on Camp Lemonnier, Djibouti. 
The team conducts monthly quality control testing in conjunction 
with daily testing by the camp's water production plant to ensure 
the safety of the drinking water. (Photo by Mass Communication 
Specialist 1st Class Eric Dietrich) 





JSC 




m 



Photo by Mass Communications Specialist 2nd Class Greg Mitchell 



Medical and Rehabilitative Care 

The third pillar of FHP, Medical and Rehabilitative Care, 
describes the continuum of care for the Wll population from 
the battlefield first responder, through in-theater resuscitation 
and hospitalization, to definitive care and rehabilitation in 
the contiguous United States. BUMED charged NMCPHC 
to assess wounded warrior care across the Navy Medicine 
enterprise, determine the impact on resources, and evaluate 
the effectiveness of clinical processes for recent signature 
wounds (i.e., TBI, PTSD, behavioral health, substance abuse, 
and amputations) and other conditions impacting Wll service 
members. In response, NMCPHC initiated the Wll 141 Project. 

NMCPHC evaluated the study methodology and clinical health 
outcomes for multiple Wll projects to describe the effectiveness 
and cost efficiency of programs that address Wll health concerns. 
The command provided subject matter expertise in developing 
project outcome metrics, assisting 11 other Wll projects in 
implementing and reporting quarterly metrics. NMCPHC also 
produced quarterly statistical analyses and data visualization 
reports detailing outcomes and trends in access to care (ATC), 
quality of care (QOC), and transition of care (TOC). These reports 
validated the need to improve case management documentation 
and were instrumental in revising resource and case management 
policies to improve the Wll continuum of care from active duty to 
veteran status. Analyses included: 



► ATC Quarterly Reports analyzed trends on access to mental 
healthcare for the Wll population. Developed clinical care 
efficiency metrics on wait times in deployment health clinics. 

► QOC Quarterly Reports analyzed trends on known high 
volume, high risk, and high cost conditions affecting the Wll 
population— including TBI, PTSD, MDD, and SUD. 

► TOC Quarterly Reports provided descriptive analysis of case 
management issues and the demand for medical services 
among Navy Medicine beneficiaries. 

The Wll 141 Project experts produced analytic reports of 
behavioral and mental health outcomes— including PTSD, MDD, 
mTBI, and SUD— for multiple Wll stakeholders. NMCPHC also 
analyzed mental healthcare demands across the Wll population 
to address inquiries from Navy and Marine Corps leaders and 
U.S. Congress. These reports described the effectiveness of, 
and demand for, behavioral health services to support programs 
that improve access to patient-centered care. The reports which 
addressed underserved Wll populations in addition to broader 
beneficiaries of the DHA included: 

► Behavioral Health Integration Program-Medical Home Port 
(BHIP) program evaluation providing support through metric 
design, data collection, and statistical analysis. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 13 



MEDICAL AND REHABILITATIVE CARE 



► Comprehensive network referral reports for mental health 
purchased care in fiscal years 2008-2012. 

► Navy Hospital Beaufort's Re-Engineering Systems of Primary 
Care Treatment in the Military (RESPECT-Mil) Program 
Evaluation Plan to review program effectiveness, including 
program evaluation assistance and participant demographics 
forBUMED. 

► Post- Deployment Medical Utilization Assessment of a 
Guantanamo Bay (GTMO) Guard unit to determine if 
heightened stress levels among Reserve Guard members 
resulted in increased use of clinical resources. The report 
helped justify the need for additional stress management 
training for the Reservists. 

NMCPHC identified patient encounters within the amputee 
population associated with comorbidity to include MDD, TBI, 
PTSD, stress, nutrition deficiency, tobacco use, and SUD. The 
analysis showed trends of increased care for behavioral health, 
along with referrals for nutrition counseling and tobacco use, for 
patients with traumatic amputations. The report, Health Promotion 
and Wellness Resources to Assist Wounded, III, and Injured 
Sailors and Marines with Traumatic Amputations, emphasized the 
health promotion resources developed to prevent, mitigate, and 
reduce these conditions during the early phases of treatment and 
rehabilitation of Wll members. 

At BUMED M3's request, NMCPHC determined the prevalence 
of chronic pain across the Navy and Marine Corps population, 
detailed in Spotlight 3, to understand factors that contribute to 
this health issue. NMCPHC reports also resulted in initiatives to 
reduce Emergency Department (ED) direct and purchased care 
costs at Navy MTFs within Navy Medicine East, including: 

► ED Utilization Analysis that supported the Medical Home 
Port champions at Naval Hospital (NH) Camp Lejeune, NH 
Jacksonville, Naval Medical Center (NMC) Portsmouth, and NH 
Pensacola in identifying ED high utilizers. This analysis has the 
capability to support the transition to DHA, providing the same 
robust analysis for all services. 

► At the request of the U.S. Fleet Forces Command (USFF) 
Surgeon, NMCPHC conducted an ED utilization analysis 
to measure use of direct and purchased care emergency 
departments by active duty Sailors assigned to operational 
forces in the Tidewater region. The report assists USFF 
leadership in understanding ED utilization trends and access to 
care issues among operational forces. 



These reports enabled operational commanders and healthcare 
providers to make informed decisions on policies and practices to 
treat and prevent deployment-related illnesses and injuries. As the 
draw-down of combat forces continues, NMCPHC's evaluation of 
medical and rehabilitative care programs becomes increasingly 
relevant as the command continues to support the Wll population. 



Spotlight 3. Understanding the 
Impact of Chronic Pain in the Navy 

The prevalence of chronic pain in the 
U.S. military is unclear. However, there 
is increasing recognition that chronic 
pain is a multifaceted disorder with 
considerable disability for the patient 
and a burden to military readiness 
and the healthcare system. BUMED 
M3 requested NMCPHC conduct an 
analysis on the prevalence of non- 
cancer chronic pain across the Navy 
and Marine Corps population for 
FY2012. The analysis helped leadership 
thoroughly understand the nature 
of chronic pain, its prevalence, and 
predisposing factors. The resulting 
report developed by the Health Analysis 
Department exceeded expectations and 
was commended by BUMED M3 as 
being "exceptionally impressive." Navy 
Medicine plans to use this information 
to provide the most effective mitigation 
and management strategies with the 
goal of reducing the overall burden of 
pain among beneficiaries and reducing 
healthcare costs. 



Medical and Rehabilitative Care - 

comprehensive medical support to 
Wll service members anywhere in 
the world. 



14 Wounded, ill, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




NMCPHC Mill Program Products and Services 

The products and services provided by the NMCPHC Wll Program are critical in addressing the healthcare needs of Wll Sailors and 
Marines. These programs enhance all three pillars of FHP and promote healthy lifestyle choices, protect against environmental health 
hazards, improve clinical results, and reduce healthcare expenses. The following sections showcase the products and services of 
each Wll project along with the associated outcomes and impacts that align to the FHP pillars and public health focus areas. 



"We are excited and proud to see NMCPHC products and services directly impacting Sailors, Marines, and their families. 
Making a difference in the lives of our warfighters and arming leadership with information they need to make effective and 
informed decisions related to healthcare is a task we are proud to uphold." 

- Commander Amy Drayton, Director of Population Health at NMCPHC 



Wll 141 Project: Expanded Surveillance and Metrics Support 

Clinical health analysis and epidemiological surveillance are essential for improving and sustaining the efficacy of Navy healthcare. 
The Wll 141 Project, supported by the Health Analysis (HA) and EpiData Center (EDC) Departments, provides leadership with 
accurate and timely health informatics and public health surveillance to support strategic decisions on military healthcare policies and 
programs. Some of these policies and programs included the RESPECT-Mil Program, the U.S. Navy and Marine Corps Reserves 
Psychological Health Outreach Program, the Naval Special Warfare Program, and the TBI Treatment and Cognitive Rehabilitation 
Program. In FY2013, the experts within the Wll 141 Project applied their knowledge and best practices to several key medical areas 
including TBI care, suicide prevention, and behavioral and psychological healthcare that shaped crucial decisions on healthcare 
policies, interventions, and programs. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 
HEALTH ANALYSIS 

HEALTH ANALYSIS 

The HA Department promotes force readiness and improves from service and government agencies, including from the Chief 
healthcare for Wll Sailors and Marines by analyzing areas for Medical Officer at TRICARE Management Activity (TMA), for the 
cost efficiency, reducing process variation in clinical practices, products and services listed in the following tables, 
and ensuring the development and implementation of quality 
healthcare services. In FY2013, HA received positive recognition 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Suicide 

Healthy and Fit 
Force 


OPNAV N171 Suicide Case Review 

Conducted an annual suicide case review and provided analytical support for OPNAV 
N171 for suicide data analysis; requested by BUMED. 


Provided analytic support for 
Navy suicide studies that directly 
informed healthcare leaders 
and policy makers on program 
effectiveness and potential 
interventions to prevent suicide. 


Navy Surgeon General Suicide Case Review 

Reviewed suicide cases from January 2011 to October 2012 in collaboration with EDC, 
HPW, and others to identify patterns, evaluate existing programs, determine potential 
intervention points, and assess data quality. 


Behavioral and 
Mental Health 

Healthy and Fit 
Force 

Medical and 

Rehabilitative 

Care 


Behavioral Health Integration Program - Medical Home Port Evaluation 

Executed program evaluation to support BUMED BHIP through metric design, data 
collection, and statistical analysis. 


Completed analytic reports on 
mental healthcare demands 
across the Wll population to 
address inquiries from U.S. 
Congress and Navy and Marine 
Corps leadership. Evaluated the 
effectiveness of and demand 
for behavioral health services 
to support programs focused 
on improving ATC through 
the establishment of patient- 
centered care. Addressed 
underserved Wll populations in 
addition to broader beneficiaries 
oftheDHA. 


Baseline Needs Assessment/Data Collection Template 

Performed baseline analysis with the NMC Portsmouth Psychology Clinic to plan a 
restructuring of mental healthcare delivery by implementing an empirically-supported 
program of treatment. Information allowed the clinic to standardize appointment 
scheduling and program evaluation. 


Network Referral Reports 

Completed three unique reports focusing on network referrals of patients with a mental 
health diagnosis to network purchased care for FY2008-2012. The reports focused on 
Marines within the network, referrals to purchased care facilities from mental health 
clinics, and PTSD, anxiety, and depression referrals to purchased care facilities. 


Program Evaluation Plan for BUMED M9/NH Beaufort's RESPECT-Mil Program 

Developed a report on the RESPECT-Mil program's effectiveness, including program 
evaluation assistance and participant demographics. 


Post-Deployment Medical Utilization Assessment 

Conducted an assessment for select members of a shipboard GTMO Guard and Central 
Command unit, to determine if increased use of clinical resources resulted from stress 
levels observed in reserve GTMO guard unit. The report helped justify the need for 
additional training for the Reservists. 


Mental Health Utilization for Children with Deployed Parents 

Provided a report on behavioral healthcare utilization and trends in mental health 
diagnoses among children of active duty Sailors and Marines in relation to the parental 
deployment history; the report guides resource allocation and program planning for the 
BUMED M9 Family Programs Division. 



16 Wounded, ill, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 

HEALTH ANALYSIS 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Domain Metrics 
Assessments 

Medical and 

Rehabilitative 

Care 


ATC Quarterly Reports 

Provided reports with analysis and trending results on mental healthcare access and 
clinical care efficiency metrics for the Wll population. 


Created extensive statistical 
analyses and data visualization 
reports detailing outcomes 
and trends in ATC, QOC, 
and TOC. Provided BUMED 
insight into network costs, 
staff efficiency in meeting 
demand for services, trends 
in mental health conditions, 
and beneficiary categories that 
drive the demand for services 
to improve the Wll continuum of 
care from active duty to veteran 
status. Demonstrated case 
management documentation 
needs improvement across Navy 
Medicine. 


QOC Quarterly Reports 

Provided reports with analysis and trending results on known high volume, high risk, and 
high cost conditions affecting Wll Sailors and Marines— including mTBI, PTSD, MDD, 
andSUD. 


TOC Quarterly Reports 

Provided reports to determine pertinent information on case management issues and 
describe the level of multidisciplinary care and demand for services among Navy 
Medicine beneficiaries to ensure appropriate resource allocation. 


Case Management Reports 

Provided reports on case management coding compliance as needed to BUMED M9 to 
support quality improvement efforts. Disseminated to all regions, MTFs, and business 
operations staff to raise awareness across Navy Medicine on compliance issues and 
delivered training examples used during site visits to educate MTFs on proper case 
management documentation. Improved documentation of case workload supports 
evidence-based decision making related to funding and resourcing. 


Wait Times in Deployment Health Clinics Assessment 

Conducted a program evaluation to examine the effect of personnel expansion in 
deployment health clinics on wait times and the number of visits over time; the evaluation 
was used to assess the impact of Wll funding for clinicians across the enterprise. 


BUMED M9 
Appointed 
Wll Project 
Evaluations 

Medical and 

Rehabilitative 

Care 


Navy Medicine Hearing Conservation Program (Wll Project #W139) 


Provided study methodology 
and clinical health outcomes 
expertise to assist with quarterly 
reporting and analysis for Wll 
projects under the ATC and 
QOC domains. Consultations 
improved data quality and 
collection practices across 
all projects and the ability 
of Navy Medicine to assess 
project success and return on 
investment. 


Comprehensive Aesthetic Restorative Effort (CARE) (Wll Project #163) 


CARE-NMC Portsmouth (Wll Project #163A) 


Orofacial Pain Position (Wll Project #W166) 


Navy Medicine's Reintegration and Education Program (Wll Project #W184) 


Wounded Warrior Psychological Health Recovery (Wll Project #W186) 


Naval Health Clinic New England TBI Program (Wll Project #W190) 


NMC San Diego Medical and Surgical Simulation (Wll Project #W207) 


NH Jacksonville Wounded Warrior Mental Health Rehabilitation Program 
(Wll Project #223) 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 17 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 
HEALTH ANALYSIS 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


BUMEDM9 
Appointed 
Wll Project 
Evaluations 

Medical and 

Rehabilitative 

Care 

(continued) 


Physical and Occupational Therapy Department Needs for Wounded Care 
(Wll Project #W223) 


Provided study methodology 
and clinical health outcomes 
expertise to assist with quarterly 
reporting and analysis for Wll 
projects under the ATC and 
QOC domains. Consultations 
improved data quality and 
collection practices across 
all projects and the ability 
of Navy Medicine to assess 
project success and return on 
investment. 


Prosthetics for Navy Medicine West (Wll Project #W225) 


Functional Recovery Program for PTSD and TBI in NH Jacksonville 
(Wll Project #226) 


NH Jacksonville Wounded Warrior Rehabilitation Program 
(Wll Project #W230) 


Deputy Officer in Charge, Operational Forces Medical Liaison (Wll Project #W231) 


TBI 

Assessment 
and Metrics 
Development 

Protection and 
Prevention 


TBI Data Collection Tool 

Developed a standardized data collection process to provide a global view of program 
effectiveness. 


Conducted data analyses and 
completed reports on TBI and 
mTBI prevalence and related 
healthcare needs to identify 
MTFs that require resources to 
care for Wll service members. 
Standardized metrics to allow 
Navy Medicine to compare and 
assess TBI programs and care 
across the enterprise. 


mTBI Needs Assessments 

Conducted three assessments on the mTBI burden at Navy MTFs, directly supporting 
enterprise-wide TBI program planning. 


TBI Site Validations 

Provided a report on the number of active duty, guard, and reserve hospitalizations 
for TBI in direct and purchased care from 2012 to present, in preparation for TBI Site 
Validations for NMC Portsmouth, NMC San Diego, and NH Camp Lejeune. Data allows 
BUMED M96 to determine if correct category ratings are assigned to each MTF. 


SUDand 
Tobacco 
Cessation 

Healthy and Fit 
Force 


National Defense Authorization Act (NDAA) Analysis 

Executed a 1-day turnaround assessment for the Office of the Chief Medical Officer at 
TMA regarding compliance with the NDAA of 201 0 to facilitate continued funding under 
future NDAAs. 


Conducted data analysis and 
implemented metrics to assess 
and reduce substance abuse 
and tobacco use rates - two 
health behaviors that directly 
impede recovery among Wll 
service members. Incorporated 
tobacco cessation metrics into 
the Population Health Navigator 
Dashboard for customers across 
Navy Medicine to view and 
assess MTF performance. 


Tobacco Cessation Metrics 

Analyzed three tobacco cessation metrics developed by HA to improve the validity and 
reliability of Navy Medicine tobacco use data collection and fidelity. Developed metrics 
based on clinical practice guidelines for treating tobacco use and dependence that aim 
to standardize Navy Medicine's diagnosis process and documentation in patient records. 
BUMED M3 uses the information in MHP briefs to help MTFs manage evidence-based 
recommendations related to tobacco use. 



18 Wounded, ill, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141 PROJECT: EXPANDED SURVEILLANCE 



AND METRICS SUPPORT 
HEALTH ANALYSIS 



Focus Area 

Pillar 




Key Product 




Returns/Outcomes 


Emergency 
Department 

Medical and 

Rehabilitative 

Care 


ED High Utilizer Analysis 

Conducted an analysis to support the MHP champions at NH Camp Lejeune, NH 
Jacksonville, NMC Portsmouth, and NH Pensacola in identifying ED high utilizers. 


Influenced initiatives to reduce 
ED expenses at Navy MTFs 
within Navy Medicine East. In 
addition to reducing the number 
of unnecessary ED visits, 
data provided allows facilities 
to improve ATC and QOC by 
directing non-emergent cases to 
other military medical resources. 


ED Utilization Analysis Expansion 

Expanded the ED utilization analysis to include the forces afloat in the Tidewater region 
for FY2012 at the request of the U.S. Fleet Forces Command Surgeon. Report compared 
number of visits, location of services, and chief complaint diagnoses among operation 
and non-operation forces to measure use of purchased care emergency and urgent care 
sites. 


Patient and 

Provider 

Outreach 

Protection and 
Prevention 


Antibiotic Utilization for Viral Respiratory Illness, DOD beneficiaries, CY2011-2012 
Communications Products 

Developed outreach materials to reduce unnecessary prescriptions that result in a 
potentially avoidable loss of over $5.1 million ($895,565 attributed to the Navy). HA report 
found that twenty-five percent of the time, an antibiotic was prescribed unnecessarily for 
a viral respiratory illness. 


Enabled Sailors, Marines, and 
their families to use information 
and resources to engage in 
healthcare conversations and 
manage their own health risks, 
positively affecting the quality 
of life and the care delivered in 
MTFs. 


Sleep Health 

Healthy and Fit 
Force 


Active Duty Sleep Disorders 

Conducted an analysis of sleep disorders and associated comorbidities in collaboration 
with HPW to provide evidence for the development of health promotion materials. Report 
developed by HPW distributed to 784 medical professionals to raise awareness on how 
to address sleep disturbances. 


Created data analysis report 
on sleep disorders and 
comorbidities for HPW to 
promote healthy sleep habits - 
an important factor that supports 
mental health and wound healing 
among the Wll population. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 19 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 
EPI DATA CENTER 



EPIDATA CENTER 



EDC epidemiologists and information technology experts design 
analytic tools and conduct population health surveillance to improve 
military readiness through disease and injury prevention programs. 
These experts provide near real-time reporting on outcomes from 
deployment-related exposures and health trends affecting Wll 
service members including mental health disorders, amputations, 
and suicide ideation. In FY2013, EDC expanded its data capabilities 
by utilizing Geographic Information Systems (GIS), a capability 



Focus Area 

Pillar 



Ongoing 
Surveillance 



Protection and 
Prevention 





Key Product 



Annual Injury Reports for U.S. Navy and Marine Corps 

Provided reports using medical encounter records at MTFs to assess the number 
of injuries reported each year and the injury rates in subordinate commands. Injury 
prevalence rates improve BUMED's ability to effectively and efficiently allocate resources. 

Integrated Disability Evaluation System (IDES) Monthly Report 

Conducted an analysis of Medical Evaluation Boards (MEB) and referrals from the IDES. 
Identified MTFs that have met the MEB stage goal of completion within 35 days and the 
referral goal of less than 10 days. 

Monthly and Yearly Force and Fleet Health Reports 

Produced reports to identify the following: behavioral health outcomes including PTSD, 
TBI, MDD, and SUD; prevalence rates of extended psychotropic medication use; and 
positive self-screens of behavioral health conditions on the PDHRA. Reports were the 
leading source for Headquarters and Force and Fleet Surgeons to evaluate population 
health and assess trends. Annual report reflected data for CY2012. 

Civil Engineering Corps Force Health Surveillance Report 

Developed a report detailing monthly trends of behavioral health encounters, TBI, positive 
behavioral health screens on the PDHRA, and extended use of prescription medications 
forCY2012. 

Monthly TBI and mTBI Incidence Reports 

Developed data analysis and reports on TBI incidence in the Navy and Marine Corps. 
Updated report reflects new case definitions and TBI severity categories used by BUMED 
to identify changing trends and build policies. 



across both EDC and HA, and new data sources in disease 
surveillance including the Theatre Medical Data Store. EDC 
collaborated with other military organizations by offering analytics 
and epidemiological consultation, as demonstrated during the 2012 
Navy Surgeon General Suicide Case Reviews. EDC addressed 
additional needs of key Wll stakeholders through the products and 
services contained in the following tables. 



Returns/Outcomes 



Generated reoccurring reports 
on Wll-related illnesses and 
injuries to provide current 
epidemiological surveillance. 
Identified injuries and illness 
having the greatest effect on 
service members to influence 
specific prevention strategies 
that minimize the impact of 
preventable injury and disease 
and improve military health 
readiness. 



Navy Expeditionary Combat Command Wll Registry 

Produced monthly database registry of NECC service members diagnosed with injuries and 
behavioral health conditions. 



PTSD Quarterly Report 

Analyzed PTSD incidence rate covering all new PTSD cases from 2002 through 2012. 
BUMED used the report to identify changing trends and support policy decisions. 



Quarterly Alcohol and Substance Abuse Incidence Report 

Determined prevalence of alcohol and substance abuse/dependence among Navy and 
Marine Corps service members as requested by BUMED. 



20 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 

EPIDATA CENTER 



Focus Area 

Pillar 




Returns/Outcomes 


BUMED M9 
Appointed 
Wll Project 
Evaluations 

Medical and 

Rehabilitative 

Care 


Combat Trauma Registry Expeditionary Medical Encounter Database (Wll Project #89) 


Provided analytic and 
consultation support to assist 
with quarterly reporting and 
analysis for Wll projects. 
Consultations improved data 
quality and collection practices 
across all projects and the ability 
of Navy Medicine to assess 
project success and return on 
investment. 


U.S. Navy and Marine Corps Reserves Psychological Health Outreach Program 
(Wll Project #90) 


Returning Warrior Workshop (Wll Project #91) 


Naval Special Warfare Resilience Program (Wll Project #93) 


Case Management and Coordination for Wounded Warrior Regiment (Wll Project #95) 


Integrated Disability Evaluation System (Wll Project #W100) 


TBI Treatment and Cognitive Rehabilitation Program, NH Camp Lejeune 
(Wll Project #172) 


TBI and Related Disorders Mobile Assessment Unit (Wll Project #178) 


BUMED M9 
Internal Metrics 

Protection and 
Prevention 


Burden of War-related Amputations Among Navy and Marine Corps 


Conducted statistical analyses 
and outcome assessments of 
Wll 141 metrics and surveillance 
and screening domain-level 
metrics. Reported quarterly to 
inform ongoing initiatives and 
identify trends in injury and 
behavioral health. 


mTBI Incidence 


Number of Marines Predicted to Return from Deployment 


PTSD Burden by MTF, Active Duty Navy and Marine Corps 


Predicting PTSD, TBI, and MDD in Marines Expected to Return from Deployment by 
Assigned MTF 


Total Predicted Encounters in Assigned MTF 


TBI in Garrison 


irenas in i bi rrevaience 


Amputations 

Healthy and Fit 
Force 


Amputation Line List for Wounded Warrior Regiment 

Developed database registry of U.S. Marine Corps (USMC) traumatic amputation 
provided to Wounded Warrior regiment medical staff for the identification and 
confirmation of amputations within the USMC. 


Provided an analysis and 
baseline for tracking war-related 
amputations to improve access 
to care and assess burden on 
the healthcare system. 


Burden of War-Related Amputation among U.S. Navy and USMC 

Provided retrospective assessment of war-related amputation and infections within the 
DON from 2001-2011. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 21 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 
EPI DATA CENTER 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Behavioral and 
Mental Health 

Healthy and Fit 
Force 

Protection and 
Prevention 


7th Marines Division (MARDIV) Force Health Surveillance Report 

Provided rates of behavioral health outcomes by unit for the 7th MARDIV including 
PTSD, depression, alcohol abuse, and suicide/homicide risk. 


Conducted analytic reports of 
behavioral and mental health 
outcomes— including PTSD, 
MDD, TBI, and SUD— for multiple 
Wll stakeholders. Enabled 
operational commanders and 
healthcare providers to make 
data-driven decisions on policies 
and practices that help treat 
and prevent deployment-related 
illnesses and injuries. 


Alcohol Abuse/Disorder and Comorbid Conditions 

Conducted an analysis to identify active duty USMC service members with alcohol 
abuse/disorder and comorbid behavioral health conditions throughout treatment; 
provided to the USMC Substance Abuse Program to evaluate and revise program. 


Alcohol and Substance Abuse Quarterly Incidence Report 

Developed a report detailing alcohol and substance abuse among Navy and Marine 
Corps service members; provided to BUM ED M9 and the Vice Chief of Naval 
Operations in response to increasing substance abuse. 


Comparison of Selected Behavioral Health Conditions, Injuries, and 
Communicable Diseases in Standard Ambulatory Data Record (SADR) and 
Comprehensive Ambulatory Professional Encounter Record (CAPER) 

Provided ambulatory and inpatient analysis of select diseases and conditions to 
enhance case capturing. 


Descriptive Analysis of Sleep Disorders in Navy and Marine Corps Service 
Members 

Assessed sleep disorders among Sailors and Marines from 2002-2012; distributed to 
BUMED and USMC medical leadership. 


DON Psychotropic Prescription Drug Use 

Analyzed prescription patterns of psychotropic drugs in response to a major campaign 
to prevent suicides and reduce substance abuse. 


Force Health Surveillance Report, 1st Marine Logistics Group 

Analyzed results from the I Marine Expeditionary Force (I MEF) Force Health 
Surveillance Report stratified by deployment status, gender, and occupation specialty 
per Major Subordinate Command. The results were used to target particular risk factors 
associated with the highest rates of behavioral health conditions. 


Prevalence of Behavioral Health Conditions, I MEF 

Developed a report to detail prevalence of Marines who actively seek treatment for 
selected behavioral health conditions in I MEF as requested by I MEF Force Surgeon. 


PTSD and Psychotropic Medicine 

Provided PTSD and psychotropic drug use rates for a brief to the Assistant 
Commandant of the Marine Corps. 


Returning Warrior Workshop and Psychosocial Health Pathways Tier III Review 

Supplied medical encounter and deployment health assessment data for a BUMED 
review of programs assessing the effect of program participation on a variety of 
satisfaction and outcome measures, including psychological health and medical 
utilization. 



22 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 

EPIDATA CENTER 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Behavioral and 
Mental Health 

Healthy and Fit 
Force 

Protection and 

Prevention 

(continued) 


Review of Mental Health Dispositions for DON Physical Examination Board (PEB) 

Conducted an analysis for BUMED M9 of all DON personnel that received a separation or 
temporary retirement for disability determination at the PEB. 


Conducted analytic reports of 
behavioral and mental health 
outcomes— including PTSD, 
MDD, TBI, and SUD-for 
multiple Wll stakeholders. 
Enabled operational 
commanders and healthcare 
providers to make data- 
driven decisions on policies 
and practices that help treat 
and prevent deployment- 
related illnesses and injuries. 


USMC Alcohol and MDD Demographic Report 

Provided a report detailing demographic characteristics of service members with MDD or 
alcohol abuse encounters for CY2012. The report was used by USMC Operation Stress 
Control Program to aid in directing care and services allocation. 


USMC Explosive Ordinance Disposal (EOD) Health Surveillance Report 

Developed three reports detailing MDD and alcohol use among EOD service members. The 
report was used by Combat Engineers to evaluate the EOD Decompression Program. 


Medical 
Injuries 
Reports 

Protection and 
Prevention 


Annual Injury Reports 

Provided annual injury reports at the Echelon 2 level for all Navy and Marine Corps active 
duty personnel. These reports generated numerous follow-up reports to focus on specific 
injuries or populations. 


Supplied analytic data 
reports to evaluate 
prevention efforts, target 
injury prevention efforts, and 
to assess the extent and 
types of injuries experienced 
by service members and 
treated by Navy Medicine. 


Agile Capabilities, Deployment Limited Conditions Metric 

Provided metric analysis and quarterly updates of deployment limiting conditions, such as 
behavioral health conditions and orthopedic injuries in shipboard Navy service members. 


Annual Medical Event Report 

Created a report identifying service members who were reported for any condition outlined 
in the Armed Forces Reportable Medical Event Guide. 


Hearing Loss and Tinnitus in Active Duty Marines, 2009-2012 

Generated a report summarizing all USMC hearing loss cases, including audiometric 
testing. 


Foot and Ankle Crush Injuries among Marine Combat Engineers 

Conducted an analysis of foot injuries at Camp Lejeune from 2011 to 2012. 


IDES Medical Evaluation Boards by Navy Medicine Region 

Provided data on the number of service members who completed a MEB and the average 
completion time within IDES. 


Physical Readiness Information Management System (PRISM) Active Duty U.S. Navy 
Medical Waivers, 2010-2012 

Developed a report analyzing the waivers of the physical readiness test for service 
members. 


U.S. Marine Corps Genital Injury Roster 

Developed a report requested by the Wounded Warrior Regiment that identified cases of 
genital injuries for the case finding and burden confirmation of genital injuries in the USMC. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 23 



Wll 141 PROJECT: EXPANDED SURVEILLANCE AND METRICS SUPPORT 
EPI DATA CENTER 



Focus Area 

Pillar 




Key Product 


Returns/Outcomes 


Suicide 

Healthy and Fit 
Force 


OPNAV N171 Suicide Case Review 

Conducted an annual suicide case review and provided analytical support for OPNAV 
N171 for suicide data analysis; requested by BUMED. 


Completed suicide analysis; 
used reports to identify 
risk factors and prevention 
approaches for suicide 
vulnerability and ideation 
among Wll service members. 


Navy Surgeon General Suicide Case Review 

Reviewed suicide cases from January 2011 to October 2012 in collaboration with HA, 
HPW, and others to identify patterns, evaluate existing programs, determine potential 
intervention points, and assess data quality. 


Attempted Suicides in the U.S. Navy, Calendar Years 2010, 2011 

Provided a proposal to the U.S. Navy on suicidal behaviors and suicides to improve 
knowledge of suicidal trends among Sailors and aid in the identification of treatment 
methods and intervention programs. 


Traumatic 
Brain Injury 

Protection and 
Prevention 


Annual Surveillance of TBI 

Developed a report to provide yearly incidence and prevalence trends of TBIs among 
active duty Navy and Marine Corps service members. The report provided detailed 
information on severity, follow-up care, and demographics. 


Developed analytical 
surveillance reports used 
to assess TBI burden and 
incidence in service members. 


Incidence and Prevalence of TBI in II MEF Marines 

Generated a report that provided incidence and prevalence of TBI in II MEF for CY2012 by 
unit. The report was used by II MEF Force Surgeon. 


TBI Ambulatory/lnpatient Encounters at identified MTFs 

Provided active duty and reserve hospitalization data to BUMED M96 in preparation for 
site validations at NMC Portsmouth, NH Camp Lejeune, and NMC San Diego; assisted in 
determining correct MTF category ratings. 



24 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




W II 141A Project: Health Promotion and Wellness 

Wll service members frequently remain with their parent commands in non-WII focused environments where health or lifestyle 
behaviors may not be appropriately addressed and negatively impact healing, resilience, and recovery. The HPW Project develops 
products, services, and programs in support of force health readiness and resilience, offering unique solutions to meet the needs of 
the Wll population no matter where they are located. HPW resources arm healthcare professionals with Wll-tailored products and 
services to prevent illness and injury, hasten recovery, and promote healthy behaviors in a way that is relevant, appropriate, and 
timely for Wll members. During FY2013, the HPW Department further developed and expanded programs and resources for Wll 
members, their families, caregivers, and others who support and assist Wll members during the recovery and transition process. 
The tables below outline these essential programs and resources to promote and sustain healthy lifestyle behaviors. 



Focus Area 

Pillar 



Case 

Management 
and Provider 
Resources 



Healthy and Fit 
Force 



Key Product 



Case Management Resources 

Created nine fact sheets for case managers to utilize with Wll 
patients in the constraints of limited time and knowledge on healthy 
lifestyle behaviors. 

www.med.navy.mil/sites/nmcphc/wounded-ill-and-injured/pages/ 
case-management, aspx 

Wll Resources listed In National Resource Directory (NRD) 

Added six NMCPHC Wll resources to the NRD to decrease 
redundancy and overlap in information as well as enhance NRD as 
a tool for Navy case managers. 
www.nrd.gov/health/healthy_living/wellness_and_fitness 



Returns/Outcomes 



Analyzed the results of a previously conducted needs 
assessment with case managers to determine what 
services, tools, and educational resources are most 
supportive to help them address the health behavior 
needs of the Wll population. Since the update and 
development of new resources, the case manager 
webpage is consistently one of the most viewed Wll 
pages each month and the fourth most viewed Wll 
page for FY2013. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 25 



Wll 141A PROJECT: HEALTH PROMOTION AND WELLNESS 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Strategic 
Outreach to Wll 
Stakeholders 

Healthy and Fit 
Force 


Fleet Outreach 

Presented information on the HPW campaign, including tailored Wll products and services, 
during HPW Awareness Days to educate Sailors and Marines on health behaviors and increase 
awareness of HPW materials. This included 10 ships and shore-based commands, reaching 
approximately 1 ,426 Sailors and Marines. 


Increased awareness of 
Wll products, materials, 
and services. Provided 
the latest information 
and resources virtually to 
Navy and Marine Corps 
personnel worldwide on 
a variety of topics to help 
address the needs of the 
wounded, ill, or injured. 


Navy HPW Course: Impact of Health Behaviors on Recovery and Resilience for Wll 
Service Members 

Conducted 3-day training courses that address the effects of health behaviors on the recovery 
of Wll Sailors and Marines to increase awareness among health promotion staff and improve 
their ability to serve the needs of the Wll population. Key topics included healthy eating, active 
living, tobacco free living, relationship issues, psychological and emotional well-being, injury and 
violence free living, and preventing drug abuse and excessive alcohol use as well as the impact 
of health behaviors on TBI, PTSD, and amputations. 


Wll Virtual Town Hall: Addressing the Needs of the Wll Population 

Conducted a webinar to provide resources available from various entities to include HPW, Navy 
Wounded Warrior-Safe Harbor, and Wounded Warrior Battalion East that meet the needs of the 
Wll population and their caregivers and family members. 
www.med.navy.mil/sites/nmcphc/health-promotion/pages/webinars.aspx 


Road to Recovery - Healthy Living Recommendations to Incorporate into Your Recovery 
Plans 

Conducted a webinar to communicate information, importance, and relationship of nutrition, 
physical activity, and tobacco use/cessation on injury, illness, and recovery. 
www.med.navy.mil/sites/nmcphc/health-promotion/pages/webinars.aspx 


Navigating the Stages of Change 

Conducted a webinar to describe the decision making process, how individuals move through 
behavior change, and practical applications of the Stages of Change Model to health behaviors. 
www.med.navy.mil/sites/nmcphc/health-promotion/pages/webinars.aspx 


Amputation 

Medical and 

Rehabilitative 

Care 


HPW Resources to Assist Wll Sailors and Marines with Traumatic Amputations 

Generated a report identifying HPW resources for use during the early phase of treatment and 
rehabilitation of Wll service members; collaborated with EDC to analyze diagnoses of comorbid 
conditions experienced within the amputee population and consulted with Naval Health Research 
Center subject matter expert to review the report and establish a collaborative partnership. 
www.med.navy.mil/sites/nmcphc/documents/wounded-ill-injured/HPW-resources-to-assist-WII.pdf 


Promoted resources to 
address the underlying 
determinants of health 
that are necessary to 
promote a more rapid 
and successful recovery 
during the short-term 
phase of rehabilitation 
for amputees and aid in 
preventing complications 
associated with chronic 
illnesses among this 
population. 


"Life After An Amputation" Webpage 

Developed a webpage to provide resources on physical activity, assistive technology, nutrition, 
healthy living, veterans services, recreation and adaptive sports, and emotional well-being. 
www.med.navy.mil/sites/nmcphc/wounded-ill-and-injured/pages/amputee.aspx 



26 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141A PROJECT: HEALTH PROMOTION AND WELLNESS 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Behavioral and 
Mental Health 

Healthy and Fit 
Force 


Relax, Relax Toolkit 

Created a website with music, information, and resources to provide relaxation techniques, 
coping strategies, and stress relief. The toolkit website had over 300 page views in the first 
2 weeks of the tool's release in August 2013 and 429 page views in October 2013. 
www.med.navy.mil/sites/nmcphc/health-promotion/psychological-emotional-wellbeing/ 
relax-relax/pages/index.html 


Developed and refined 
resources to assist in 
addressing distress- 
related behaviors, suicide 
prevention, and aid in 
resiliency building and 
mission readiness. These 
products build on one of 
HPWs core functions, 
psychological and emotional 
well-being, to address 
a variety of populations, 
needs, and topics under this 
broader initiative. 


Suicide Prevention Webpage and Resources 

Updated and refined webpage to increase user friendliness for a variety of audiences. 
Developed targeted products with new messaging to represent different communities in 
the Fleet. 

www.med.navy.mil/sites/nmcphc/health-promotion/psychological-emotional-wellbeing/ 
pages/suicide-prevention. aspx 


OPNAV N171 Suicide Case Review 

Contributed to OPNAV N171 2011 suicide case review in identifying patterns, evaluating 
existing programs, and determining potential points of intervention to reduce suicide. 


Navy Surgeon General Suicide Case Review 

Reviewed suicide cases from January 2011 to October 2012 in collaboration with EDC, HA, 
and others to identify patterns, evaluate existing programs, determine potential intervention 
points, and assess data quality. 


Defense Centers of Excellence Virtual Mental Health Fair 

Participated in Facebook-based Virtual Mental Health Fair by hosting a booth and providing 
staff to answer questions and disseminate resources to interested target audiences such 
as Sailors, Marines, health educators, and mental health professionals. 


Navy Leader's Guide for Managing Sailors in Distress Mobile Application 

Developed a mobile application edition of the online Navy Leader's Guide handbook, in 
collaboration with National Center for Telehealth and Technology (T2), to help leaders 
recognize distress-related behaviors, provide support, and collaborate with Navy helping 
agencies. The Wll population can exhibit these distress-related behaviors including stress, 
alcohol and/or drug misuse, interpersonal relationship issues, and suicide prevention. 
www.med.navy.mil/sites/nmcphc/documents/lguide/index.aspx 


NMCPHC Psychological and Emotional Well-Being Webpage 

Updated multiple webpages to reflect new topics and enhance the delivery of resources 
that focus on increased resiliency. 

www.med.navy.mil/sites/nmcphc/health-promotion/psychological-emotional-wellbeing/ 
pages/psychological-emotional-wellbeing.aspx 


Navy Suicide Prevention General Military Training 

Coordinated with staff at Center for Personal and Professional Development to provide 
resilience and suicide prevention resources for general military training. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 27 



Wll 141A PROJECT: HEALTH PROMOTION AND WELLNESS 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Sleep Health 

Healthy and Fit 
Force 


Sleep Disorders Cross-Sectional Analysis Report 

Created a report on the prevalence of sleep disorders and related comorbidities 
within the active duty and reserve communities, many of whom are wounded, ill, or 
injured. Distributed to 784 medical professionals at various MTFs, Wounded Warrior 
Battalions, Medical Transition Units, Marine Corps Community Services, and Navy 
Wounded Warrior-Safe Harbor. 

www.med.navy.mil/sites/nmcphc/documents/health-promotion-wellness/ 
psychological-emotional-wellbeing/sleep-article.pdf 


Promoted educational products 
to raise awareness about positive 
behavior changes that can 
mitigate sleep disturbances. 


Got Sleep? 

Developed a webinar to discuss the importance of and misconceptions about sleep; 
the signs, symptoms and effects of poor sleep; types of sleeping disorders and 
issues; and helpful strategies for a good night's sleep. 
www.med.navy.mil/sites/nmcphc/documents/health-promotion-wellness/general- 
tools-and-programs/webinars/got-sleep-webinar.pdf 


Substance Use 

Healthy and Fit 
Force 

Prevention and 
Protection 


Alcohol Abuse and Drug Misuse Programs 

Updated a fact sheet with strategies to increase awareness of educational and 
training programs and intervention resources for alcohol abuse and drug misuse. 
www.med.navy.mil/sites/nmcphc/documents/health-promotion-wellness/preventing- 
drug-alcohol-abuse/alcohol-abuse-drug-misuse-programs-march-2013.pdf 


Developed educational materials 
and resources to enhance 
prevention efforts and help Wll 
service members understand the 
ramifications of unhealthy use of 
alcohol and/or prescription drugs 
as a coping mechanism or to 
relieve stress. Enabled tobacco 
cessation at the deck plate by 
providing tobacco cessation 
facilitator training for over 75 new 
facilitators on the types of tobacco 
use and the negative effects on 
health, stress, wound healing, and 
well-being. 


Tobacco Cessation Facilitator Training 

Conducted nine tobacco cessation facilitator trainings with participants from the fleet, 
dental, medical, and reserve commands. Deck plate tobacco cessation increases 
accessibility for Sailors and Marines in a variety of locations, including Wll service 
members, while saving time and productivity, and increasing access to care. 


Great American Smokeout (Nov 12) 

Collaborated with various Navy Medicine entities to promote tobacco cessation 
at NMC Portsmouth for Sailors, Marines, and other beneficiaries through various 
platforms such as social media, a blog, and an article. 



28 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




Mill 141B Project: Health Hazard Assessment 

The HHA Project analyzes occupational and environmental health surveillance data to conduct technically sound and scientifically 
defensible health hazard assessments. These assessments report to leadership the potential acute and chronic health risks 
associated with military deployments. The project also increases FDPMU readiness through the refinement of FDPMU field sampling 
protocols. These protocols allow the deployable teams to assist commanders in minimizing environmental exposures through the 
timely implementation of controls and provide recommendations for risk-based decisions about environmental exposures. The 
services and products outlined in the tables below directly support the development of Navy preventive medicine programs that 
identify, evaluate, monitor, respond to, and decrease the likelihood of experiencing diseases, injuries, and environmental factors that 
threaten human health. 



Focus Area 

Pillar 



POEMS 

Protection and 
Prevention 



Key Product 



Camp Lemonnier POEMS 

Developed a report to evaluate the health risks associated with 
environmental stressors experienced by deployed personnel at Camp 
Lemonnier. 



Camp Fallujah POEMS 

Developed a report to evaluate the health risks associated with 
chemical, biological, and physical stressors faced by deployed 
personnel at Camp Fallujah. 



Returns/Outcomes 



Built upon the foundation established by last 
year's POEMS; refined the skill sets and analytical 
processes to evaluate environmental data collected 
from site assessments, environmental samples, 
and healthcare encounters. POEMS assessed the 
significance of both short-term and long-term health 
risks for populations deployed to specific sites and 
improve population health surveillance. POEMS 
can be used to provide defensible, definitive 
assessments of deployment-related environmental 
exposures to medical practitioners, service 
members, and other stakeholders, as well as other 
services in the U.S. military. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 29 



Wll 141B PROJECT: HEALTH HAZARD ASSESSMENT 



Focus Area 

Pillar 




Key Product 




Returns/Outcomes 


POEMS 

Protection and 

Prevention 

(continued) 


Al Asad Air Base POEMS 

Developed a report to evaluate the health risks associated with chemical, 
biological, and physical stressors faced by deployed personnel at Al Asad Air Base. 


Built upon the foundation established 
by last year's POEMS; refined the 
skill sets and analytical processes 
to evaluate environmental data 
collected from site assessments, 
environmental samples, and 
healthcare encounters. POEMS 
assessed the significance of both 
short-term and long-term health risks 
for populations deployed to specific 
sites and improve population health 
surveillance. POEMS can be used 
to provide defensible, definitive 
assessments of deployment-related 
environmental exposures to medical 
practitioners, service members, and 
other stakeholders, as well as other 
services in the U.S. military. 


Camp Leatherneck/Camp Dwyer POEMS 

Developed a report to evaluate and characterize health risks at the population level 
for deployed personnel at Camp Leatherneck-Bastion and Camp Dwyer. 


Field-Portable 
Analytical 
Equipment 
Calibration 

Protection and 
Prevention 


HAPSITE ER Gas Chromatography-Mass Spectrometry (GC-MS) Calibration 

Calibrated GC-MS to validate permeation system for testing and optimization. 


Calibration is necessary to 
complete exposure assessments 
in the deployed environment that 
support real-time operational risk 
management assessments. The 
calibration helps to identify, avoid, 
and document personnel exposures 
to environmental health stressors in 
the deployed area. 


Proficiency 
Analytical 
Testing (PAT) 

Protection and 
Prevention 


Proficiency Analytical Testing 

Completed 16 rounds of training last year (4 each quarter) and resulted in a 
"Satisfactory" rating for the command and participants, including personnel from 
Navy and Environmental Preventive Medicine Units 2, 5, and 6. The PAT round 
project is ongoing. 


The PAT round project certifies 
analytically proficient healthcare 
scientists to identify, assess, and 
control personnel exposures to 
environmental health stressors in 
the expeditionary environment. 
The PAT training ensures FDPMUs 
are capable to deploy modern 
field-portable analytical equipment 
proficiently in different areas. 



30 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




W II 141C Project: Navy Entomology Center of Excellence 

Blood-feeding insects and the diseases they carry pose serious risks to the nation's warriors around the globe. Control programs 
aimed at decreasing insect populations and providing personal protective equipment play a key role in guarding deployed warfighters 
from insects that transmit life-threatening diseases. NECE provides expertise for the ongoing development of new and improved 
insecticides, application equipment and techniques, and surveillance methods and is the world's sole military-specific entomological 
research center. The NECE Wll Project continues to make significant advancements, enhancing the health and operational readiness 
of service members by constantly delivering innovative approaches for developing new chemicals, technology, and techniques that 
improve the safety and effectiveness of programs that control blood-feeding insects. In recognition of their collaborative partnerships, 
the Navy Surgeon General complimented NECE as "a great example of jointness in research and development." The tables below 
outline these achievements in safeguarding warfighters and at-risk populations. 



"The work conducted at the Navy Entomology Center of Excellence is a great example of jointness in research and 
development. NECE partnered with scientists and public health professionals from the Army Air Force, as well as the World 
Health Organization, USDA and other federal agencies to develop new insecticides, techniques and application technologies 
to control blood-feeding insects that transmit human disease that threaten the warfighter on the battlefield, such as malaria 
and dengue." 

- Vice Admiral Matthew L. Nathan, U.S. Navy Surgeon General, and Chief, U.S. Navy Bureau of Medicine and Surgery 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141C PROJECT: NAVY ENTOMOLOGY CENTER OF EXCELLENCE 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Testing and 
Evaluation 

Protection and 
Prevention 


Recognition as a WHO CC for Testing and Evaluation of Insecticide Application 
Equipment 

Phase I: NECE made great strides in becoming recognized by the WHO as a Collaborating 
Centre for the testing and evaluation of pesticide dispersal technology. Attaining this status 
will result in the following: (1) NECE serving as the only international center of excellence 
for how public health insecticides are applied— equally important as which insecticide is 
applied. NECE already earned that distinction for the DOD while also serving as the field 
testing nucleus of a highly successful consortium of U.S. federal labs, academe, and industry 
all with overlapping motives to discover new products to better protect deployed warfighters 
and global citizens from insects that transmit diseases; (2) recruitment for more collaborative 
research efforts from new national and international federal labs, universities, and industries 
which will result in additional and improved products to protect deployed warfighters from 
insects that transmit diseases; and (3) the development of new collaborative initiatives that 
help promote global health, a key national security priority for the DOD and Navy. 


Developed new technology 
to apply existing and 
novel insecticides 
and formulations 
thereby increasing the 
effectiveness of insect 
control programs, which 
resulted in a significant 
reduction of disease risk 
on the battlefield. Many 
NECE projects currently 
align with DOD's focus 
on controlling disease- 
transmitting, blood-feeding 
insects in the United States 
Pacific Command Area of 
Responsibility. Evaluation 
of the technology and 
insecticides in an 
operational setting allows 
NECE to adapt insect 
control programs to ensure 
maximum effectiveness 
in protecting deployed 
warfighters. Evaluation 
results also provide 
manufacturers with criteria 
and a way for products and 
technology to be approved 
bytheAFPMBforuse by 
all services. This results 
in the standardization of 
equipment and application 
techniques based on the 
best possible technology. 


Establishment of a Permanent NECE Facility at the Camp Blanding Joint Training 
Center, Starke, Florida 

Complete: NECE successfully leveraged numerous collaborative relationships with academia, 
industry, governmental, and non-governmental agencies to develop novel products and 
techniques reducing the risk of human disease carried by blood-feeding insects on the 
battlefield. Each breakthrough is evaluated in a field setting to ensure effectiveness and 
adherence to DOD requirements. This year, NECE and the Florida Army National Guard 
(FLANG) strengthened an already productive and ongoing relationship by establishing a 
permanent field-testing facility at the FLANG Camp Blanding Joint Training Center. NECE and 
FLANG optimized opportunities to evaluate novel vector control chemicals, equipment, and 
techniques that directly contribute to warfighter protection and exemplify the effectiveness of 
joint cooperation that characterizes the operational environment today. 


Development of Portable Sprayer to Generate a Cloud of Small Insecticide Droplets (5 
Microns) Using Sound Vibrating Technology 

Phase II: Developed portable, electrostatic equipment for residual insecticide applications to 
control blood-feeding insects resulting in three patents created by NECE. This equipment will 
play a key role in testing the validity of using electrostatics during insecticide applications to 
improve mosquito control. 


Center for Disease Control (CDC) Project Evaluating Residual Insecticides Against 
Mosquitoes on Various Surfaces (Wood, Manure/Mud Coated Panels) 

Phase I: Examined the efficacy of indoor application of a residual insecticide (Indoor 
Residual Spray) to control malaria-carrying mosquitoes in Africa. Results from this study will 
provide information useful for executing successful malaria control programs as part of the 
President's Malaria Initiative and guide design and implementation of insect-borne disease 
control programs during DOD contingency/humanitarian assistance operations worldwide. 



32 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



Wll 141C PROJECT: NAVY ENTOMOLOGY CENTER OF EXCELLENCE 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Testing and 
Evaluation 

Protection and 

Prevention 

(continued) 


Evaluation of Micro-Encapsulated Deltamethrin as a Residual Treatment to Control Mosquitoes 

Phase I: Conducted field evaluation of novel deltamethrin (pyrethroid class of insecticide) 
formulation to treat Hercules Engineering Solutions Consortium (HESCO) barriers and use 
as indoor residual spray (particularly on building material commonly used during deployments 
such as plywood) to target disease carrying mosquitoes and sand flies. Sand flies transmit 
leishmaniasis and breed in the artificial habitats created by HESCO barriers, which are widely 
used for security purposes during contingency operations. Control programs require application of 
an effective/long lasting insecticide and initial results indicate that the insecticide performed well. 


Developed new 
technology to apply 
existing and novel 
insecticides and 
formulations thereby 
increasing the 
effectiveness of insect 
control programs, 
which resulted in a 
significant reduction 
of disease risk on the 
battlefield. Many NECE 
projects currently 
align with DOD's 
focus on controlling 
disease-transmitting, 
blood-feeding insects 
in the United States 
Pacific Command 
Area of Responsibility. 
Evaluation of the 
technology and 
insecticides in an 
operational setting 
allows NECE to adapt 
insect control programs 
to ensure maximum 
effectiveness in 
protecting deployed 
warfighters. Evaluation 
results also provide 
manufacturers with 
criteria and a way 
for products and 
technology to be 
approved by the 
AFPMBforuse by all 
services. This results 
in the standardization 
of equipment and 
application techniques 
based on the best 
possible technology. 


Indoor Control of the Dengue Vector, Aedes aegypti, Using Thermal Fog, and Ultra-Low 
Volume Technologies 

Phase II: Evaluated the efficacy of applying a pyrethroid insecticide, deltamethrin, using thermal 
fog application (an unique application technique) in homes to reduce Aedes aegypti populations, 
thereby lowering the risk of dengue fever impacting DOD personnel in surrounding areas. NECE 
proved this technique is effective and recommended the equipment and insecticide be issued 
NSNs to make them available to personnel supporting deployed warfighters. 


Assessment of Compounds from the U.S. Department of Agriculture, Agricultural 
Research Service Chemical Archives for Insecticidal Activity 

Phase II: Conducted toxicological screening on adult and larval mosquitoes using compounds 
submitted by several sources including Vestergaard Frandsen, Marrone Bio Innovations, 
Chemtura, BASF, and Bayer. The screening resulted in improvements to existing products and the 
discovery of additional public health uses of compounds currently used for agricultural purposes. 
This increased the effectiveness of control programs, particularly of insects resistant to pesticides 
already in use. 


Pesticide Application Equipment Annual Evaluation 2013 

Serving as DOD's testing and evaluation center for insecticide application equipment, NECE 
hosted an annual weeklong symposium for manufacturers of insecticide dispersal equipment 
to demonstrate new products and technology allowing assessment against military-specific 
requirements. After testing, manufacturers were debriefed, providing opportunity for discussion on 
evaluation results, potential modifications, and future technology. 


Evaluation of an Intelligent Sprayer for Vegetative Barrier Applications 

Phase I: Collaborated with the U.S. Department of Agriculture, Agricultural Research Service, 
Application Technology Research Unit in Wooster, Ohio to develop "intelligent pesticide 
application sprayer" technology that senses vegetation (typical resting and breeding habitat for 
most nuisance and blood-feeding insects that carry human disease) and automatically sprays the 
area, reducing the number of applications and amount of pesticide needed for control. 


Small Carbon Dioxide (C02) Generators for Use with CDC Light Traps Evaluation 

Phase II: Evaluated the durability, usability, and efficacy of two field C02 generators produced 
from the Small Business Innovation Research Program. NECE staff made recommendations 
for improvement to the manufacturers and will provide a follow-up evaluation. Increasing C02 
availability in deployed settings will enhance insect surveillance efforts, which is critical in 
assessing disease risk and designing and evaluating control programs. 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 33 



Wll 141C PROJECT: NAVY ENTOMOLOGY CENTER OF EXCELLENCE 



Focus Area 

Pillar 


Key Product 


Returns/Outcomes 


Novel Control 
Techniques 

Protection and 
Prevention 


Two Patents for Technology Based On Previously Unknown Information that 
Flying Mosquitoes Produce a Static Electric Charge 

Phase I: NECE discovered that flying mosquitoes produce a static electric charge. From 
this discovery, a novel patent-pending sprayer is being developed that will produce a 
cloud of insecticide droplets, with the opposite static charge, that seek out and kill these 
flying mosquitoes. This sprayer will result in a significant enhancement of mosquito 
control programs and will increase the effectiveness of targeting, resulting in mortality 
of the flying mosquito thereby reducing the global impact of human disease, to include 
malaria and dengue fever. 


Improved pesticide application 
methodologies and formulations 
ensure personnel that support 
warfighters have the latest and 
most effective tools available. 




Evaluation of Novel Pesticides and Formulations for Efficacy Against Medically 
Important Mosquitoes 

Phase I: Evaluated the efficacy of the insecticide tolfenpyrad against adult mosquitoes in 
collaboration with Nichino America, a subsidiary of Nihon Nohyaku Co (Japan's first and 
oldest agrochemical manufacturing company). This contact insecticide is characterized 
by a unique mode of action, Mitochondrial Electron Transport inhibition, and short 
residual activity. Mitochondrial Electron Transport Inhibition could be used to control 
pyrethroid resistant mosquito populations. Based on initial results this insecticide showed 
promise against insects of public health importance and could be added to the DOD- 
approved list contributing to the protection the deployed warfighter. 






Evaluation of Ribonucleic Acid Interference (RNAi) to Control Disease Vector 
Mosquitoes 

Phase II: Evaluated the effectiveness of RNAi constructs targeting specific genes that 
make mosquitoes resistant to pesticides without affecting non-targets and causing 
resistance or species-specific effects. If these resistance genes are knocked down, the 
mosquito should become susceptible to the pesticide, which makes an already approved 
pesticide more useful and extends its effective period of use. 






Development of a Multi-functional, Lightweight, Durable, Powered by Compressed 
Air Backpack Sprayer to Address a Capability Shortfall Applying Residual 
Insecticides to a Variety of Substrates 

Completed: Collaborated with Dorendorf Advanced Technologies to produce the JQSX 
backpack sprayer. Recommended by the AFPMB's Equipment Committee and approved 
by the AFPMB Council, a NSN was assigned and the JQSX sprayer is now listed on the 
approved equipment list and in use by the Navy's FDPMUs. 






Investigation into Insect-Droplet Interactions Using High Speed Cameras and 
Ultra Low Volume Droplets 

Phase I: Examined the dynamics of insecticide droplet-mosquito interaction using high- 
speed photography to gather valuable data. This information guides the modification of 
insecticide formulations and delivery systems to maximize insect mortality while using a 
minimal amount of chemical product. 





34 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 




The Mission Ahead for NMCPHC 



Photo by Mass Communications Specialist 3rd Class Daniel A Barker 



The public health analyses, reports, and resources created by the 
NMCPHC Wll Program advance the ability of decision makers 
and care providers to improve the health of Wll service members. 
The command's products and services contribute across the 
spectrum of readiness, resilience, and recovery and support each 
pillar of Force Health Protection. Public health experts collaborate 
within NMCPHC and partner with organizations throughout the 
DHA to promote FHP. These teams of scientists, epidemiologists, 
statisticians, programmers, and health educators conducted 
extensive research and analysis and developed unique products 
over the past several years. Plans for FY2014 capitalize on these 
resources to further establish targeted prevention, monitoring, 
and recovery strategies and effect long-term population health 
improvements. 

Past successes of the NMCPHC Wll 141 and 141A teams 
resulted in a project request from the Office of the Secretary of 
the Navy to assess the state of prescription drug use and abuse 
problems in the Navy and Marine Corps. This is an important 
topic for the Wll population as combat exposure correlates with 
both proper use and misuse of prescription drugs. The project 
fosters collaboration across the command's clinical health 
analysis and health promotion capabilities, expands current 
support of operational force readiness, and contributes to 
substance use policy development. The report will be delivered 
to the Department of the Navy, Manpower and Reserve Affairs, 



and will include recommendations for monitoring and reducing 
prescription drug abuse to support troop deployment and 
retention. 

All NMCPHC future analysis, services, and products will strive 
to advance FHP and impact cultural changes for health and 
wellness within the DHA. The NMCPHC Wll Program will 
continue expanded efforts to promote healthy lifestyle choices 
to maintain a healthy and fit force; conduct health surveillance, 
health hazard assessment, and insect control programs to 
enhance prevention of injuries and illness and protect the force 
from health hazards; and assess medical and rehabilitative 
care to sustain world-class healthcare for Wll Sailors and 
Marines. As doctrine and military operational tempo change, 
FHP and medical care will evolve and NMCPHC is committed 
to providing relevant, cutting-edge support to Navy Medicine. 
With an uncertain future demand on U.S. military forces, 
individuals will need support to maintain readiness, enhance 
resiliency, and expedite recovery. Given continued funding for the 
NMCPHC Wll Program, the four project teams will collectively 
and individually continue to strengthen FHP and operational 
mission accomplishments, improve health outcomes, and reduce 
healthcare expenses. As the program matures, the Wll projects 
will demonstrate the full return on investment of its products and 
services through the reduced prevalence of illness and injury and 
speedy recovery in Wll service members. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 35 



THE MISSION AHEAD FOR NMCPHC 



The Expanded Surveillance and Metrics Support Project Team 
will improve epidemiological surveillance with the addition of 
in-theater data on blast exposure and concussion incidence to 
monitor the health status of U.S. troops. The team will examine all 
available healthcare data and derive more sophisticated analysis 
throughout the entire deployment cycle to measure the impact of 
Wll programs and services. Clinical resource utilization will be 
further scrutinized to ensure optimal use for the Wll population. 

The HPW Project Team will deploy the Wll HRA to Wll Sailors 
and Marines and the information will be analyzed to determine 
which behaviors are positively and negatively affecting resilience 
and recovery. The team will implement a partnership program 
to enhance collaboration with other Wll-focused organizations 
and extend the reach of HPW key messages, resources, tools, 
and programs to motivate healthy living habits. The HPW Project 
Team will deploy a comprehensive evaluation of these programs 
to monitor and improve their effectiveness. 

During the next year, the HHA Team will capitalize on the 
baseline established by subsequent POEMS to accelerate the 
evaluation of environmental data collected from site assessments, 
environmental samples, and healthcare encounters. GC-MS 
calibration, PAT, and quarterly training will continue to prepare 
field scientists with the skills needed to provide operational 
and tactical commanders timely analytical risk assessments. 
The NECE Wll Project will provide cutting-edge entomological 
technology and methodology that support the readiness of 
warriors. The advances in entomology made possible by the 
Wll project will protect human life from blood-feeding insects 
that carry human disease, yielding a lasting, positive impact on 
warfighters and military communities. 

The products and services provided by the NMCPHC Wll 
Program will remain critical to the state of readiness, resiliency, 
and recovery of the Wll population. These projects are 
now integrated into the mission operations of BUMED and 
NMCPHC. With the current state of financial instability in the 
federal government, resources allocated to the NMCPHC Wll 
Program may be decreased leading to a reduction in billets, 
and consequently, capability. NMCPHC remains dedicated to 
providing protection through prevention and hopes that the value 
of the Wll projects are realized and codified within personnel and 
fiscal allotments for the command. 




Captain Philip Blaine 
Executive Officer, NMCPHC 

"NMCPHC remains dedicated to producing data-driven 
strategies and methods to prevent illness and improve the 
physical and behavioral health of our Wll service members 
and committed to enhancing the readiness, effectiveness, 
and resilience of all Sailors and Marines. The public health 
analyses, reports, and resources created by the NMCPHC 
Wll Program advance the ability of decision makers and 
care providers to support the Wll population. The future 
of the NMCPHC Wll Program is focused on expanding 
current products and services and developing new ones 
that strengthen Force Health Protection, improve health 
outcomes, and reduce healthcare expenses." 




Master Chief Derek Petrin 
Command Master Chief, NMCPHC 

"Our subject matter experts continue to set the standard 
by providing relevant, innovative programs and services to 

support our wounded, ill, and injured warriors and those who 
care for them. The key role that NMCPHC serves for the 

Navy Medicine Wll programs epitomizes our passion to focus 
on the preservation of the fighting force and their families." 



36 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



APPENDIX A: REFERENCES 



Appendix A: References 



Adams, J. Cost savings from health promotion and stress management interventions. 

OD Practitioner 2009. http://connection.ebscohost.com/c/articles/44511171/cost-savinqs-from-health-promotion-stress- 
manaqement-interventions . 

Centers for Disease Control. Control healthcare costs. 

12/10/2013: http://www.cdc.gov/workplacehealthpromotion/businesscase/benefits/costs.html . 

Chapman, L. Meta-evaluation of worksite health promotion economic return studies. 
Am J of Health Promotion 2003; 6, 6. 

Katz, D, A AN. Preventive medicine, integrative medicine and the health of the public, Institute of Medicine Report. 
2006. National Academies of Science Press: Washington, D.C. 45 pgs. 



Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



APPENDIX B: CONTACT INFORMATION - NMCPHC Wll PROGRAM 



Appendix B: Contact Information - NMCPHC Wll Program 



Wll Program Area 


NMCPHC Point 
of Contact 


Email 


Phone 
Number 


DSN 


Wll Program Executive 
Management 


CDR Amy Drayton 


Amy.Drayton@med.navy.mil 


757-953-0957 


377-0957 


Mr William Calvert 

IVIli V Villi III wul VUl L 


William Oalvprtff^med navv mil 

V V 1 1 1 1 CI 1 1 1 ■ uul V \jl L^l 1 lUU^I ICIV V . 1 1 III 


757-953-0973 


377-0973 


Wll 141 Expanded Surveillance 
and Metrics Support 


Dr Chri^tnnhpr Rennix 

L*/ 1 ■ wl II IOLUUI 1 II 1 1 A 

(EpiData Center) 


Chri^tnnhpr Rennixf^med navv mil 

wl II lOLUul 1 \j 1 .1 II 1 lA^U II lUUil IC1Vy.il III 


757-953-0955 


377-0955 


CAPT Paul Rockswold 
(Health Analysis) 


Paul.Rockswold@med.navy.mil 


757-953-0690 


377-0690 


Wll 141 A Health Promotion and 
Wellness 


CDR Connie Scott 


Connie.Scott@med.navy.mil 


757-953-0952 


377-0952 


Wll 141 B Health Hazard 
Assessment 


CDR Doug Putthoff 


Douglas.Putthoff@med.navy.mil 


757-953-1031 


377-1031 


Mr. Steven Sorgen 


Steven.Sorgen@med.navy.mil 


757-953-0694 


377-0694 


Wll 141C Navy Entomology 
Center of Excellence 


Dr. Gary Breeden 


Gary.Breeden@med.navy.mil 


757-953-0930 


377-0930 


Wll Program Support 


Ms. Karen Jones 


Karen.M.Jones@med.navy.mil 


757-953-0709 


377-0709 


Ms. Lisa Wohlford 


Lisa.Wohlford@med.navy.mil 


757-953-6972 


377-6972 


Wll Program Support - 
Editorial Staff 


Ms. Diana Fitzgerald 
Dr. Gretchen Thompson 
Dr. Michael Krentz 
Ms. Joelle McCarthy 
Ms. Mary Collier 


NMCPHC-PopHealth@med.navy.mil 


757-953-3120 


377-3120 



38 Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 



APPENDIX C: ACRONYM LIST 



Appendix C: Acronym List 



Acronym 


Definition 


AFPMB 


Armed Forces Pest Management Board 


ATC 


Access to Care 


BUMED 


Bureau of Medicine and Surgery 


CDC 


Center for Disease Control 


C02 


Carbon Dioxide 


CY 


Calendar Year 


DHA 


Defense Health Agency 


DOD 


Department of Defense 


DON 


Department of the Navy 


ED 


Emergency Department 


EDC 


EpiData Center 


EOD 


Explosive Ordinance Disposal 


FDPMU 


Forward Deployable Preventive Medicine Unit 


FY 


Fiscal Year 


GC-MS 


Gas Chromatography-Mass Spectrometry 


GTMO 


Guantanamo Bay 


HA 


Health Analysis 


HESCO 


Hercules Engineering Solutions Consortium 


HHA 


Health Hazard Assessment 


HPW 


Health Promotion and Wellness 


HRA 


Health Risk Assessment 


IDES 


Integrated Disability Evaluation System 


M3 


BUMED Medical Operations Code 


M9 


BUMED Wound, III, and Injured Code 


MARDIV 


Marine Division 


MDD 


Major Depressive Disorder 


MEB 


Medical Evaluation Board 


MEF 


Marine Expeditionary Force 


MHP 


Medical Home Port 


mTBI 


Mild Traumatic Brain Injury 


MTF 


Military Treatment Facility 


NAVMED 


Navy Medicine 


NDAA 


National Defense Authorization Act 


NECC 


Navy Expeditionary Combat Command 


NECE 


Navy Entomology Center of Excellence 



Acronym 


Definition 


MH 
nn 


INdVdl nUo[JILdl 


NMC 


Naval Medical Center 


NMCPHC 


Navy and Marine Corps Public Health Center 


NRD 


National Resource Directory 


NSN 


National Stock Numbers 


Anil AW 

OPNAV 


Office of the Chief of Naval Operations 


nrtuD a 

PDHRA 


Post-Deployment Health Reassessment 


PEB 


Physical Examination Board 


POEMS 


Periodic Occupational and Environmental 
Monitoring Summary 


PTSD 


Post-Traumatic Stress Disorder 


QOC 


Quality of Care 


RESPECT-Mil 


Re-Engineering Systems of Primary Care 
Treatment in the Military 


RNAi 


Ribonucleic Acid Interference 


SUD 


Substance Use Disorder 


TBI 


Traumatic Brain Injury 


TMA 


TRICARE Management Activity 


TOC 


Transition of Care 


U.S. 


United States 


USFF 


U.S. Fleet Forces Command 


USMC 


United States Marine Corps 


Wll 


Wounded, III, and Injured 


WHO 


World Health Organization 


WHOCC 


World Health Organization Collaborating Centre 




Wounded, III, and Injured Project - FY2013 Annual Report: Public Health Support for Our Nation's Warriors 39 



NAVY AND MARINE CORPS PURLIC HEALTH CENTER 

PREVENTION AND PROTECTION START HERE 

Wounded, III, and Injured Project 
FY2013 Annual Report 

620 John Paul Jones Circle, Suite 1100 

Portsmouth, VA 23708-2103 

www.nmcphc.med.navy.mil 

Published: March 31,2014 




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